Amenorrhea Flashcards
(24 cards)
What is Amenorrhea?
Absense of Menstruation
What is Primary Amenorrhea?
Absence of menstruation by age 15 in female with normal secondary sex characteristics or by age 13 without secondary sexual characteristics
What are common causes of Primary Amenorrhea?
Gondal Dysgenesiis (Turner Syndrome)
Mullerian Agenesis
Delay of Puberty
PCOS
Hypopituitarism
Secondary can present as primary: rule out pregnancy
What does initial testing for Primary Amenorrhea include?
B-HCG
TSH
Prolactin
FSH
Pelvic US: assess for presence of Uterus
In the workup for primary amenorrhea If the patient has a uterus + Breasts and normal estrogen what is your next step?
Order US
In the workup for primary amenorrhea If the patient has a uterus, breasts and normal estrogen with US showing uterine anomaly what are some possible causes?
Outflow tract disorders
-Imperforate hymen
-Transverse vaginal septum
In the workup for primary amenorrhea if the patient has breasts, normal estrogen and an US that does not show a uterine anomaly what are some possible causes?
Check for underlying endocrine disorders: secondary amenorrha
In the workup for primary amenorrhea in a patient with a uterus without breasts and low estrogen what is the next step?
Order Karyotype
In the workup for primary amenorrhea in a patient with a uterus, without breasts and low estrogen what are common causes that Karyotype can help determine?
45XO: Turner Syndrome
46XY Gonadal Dysgenesis
46Xx: Primary Ovarian insufficiency
What is the karyotype for Turner syndrome?
45XO
What is the karyotype for gonadal dysgenesis?
46 XY
What is the karyotype for Primary Ovarian Insufficiency?
46XX
In the workup for primary amenorrhea without a uterus what do we look for first?
Presence of secondary sex characteristics
In the workup for primary amenorrhea without a uterus with normal secondary sex characteristics what do we order next?
Karyotype
In the workup for primary amenorrhea without a uterus and with normal secondary sex characteristics what are some possible causes that can be seen on Karyotype?
46XX Mullerian Agenesis
46XY Complete androgen Insensitivity
What is the Karyotype for Mullerian Agenesis?
46 XX
What is the karyotype for Complete Androgen Insensitivity?
46XY
In the workup for primary amenorrhea without a uterus and secondary sex characteristics that show signs of virilization what is Karyotype most likely to show?
45XY: 5-alpha reductase deficiency
What is the karyotype for 5-alpha reductase deficiency
45XY
What is the most common cause of Secondary amenorrhea?
Pregnancy
What is secondary Amenorrhea?
Absence of menses for >3 months in a female who menstruates regularly or >6 months if menstruates irregularly
What are common causes of secondary Amenorrhea?
Pregnancy
Hypothalamic Amenorrhea
Hyperprolactinemia
Primary Ovarian Insufficiency
PCOS
Thyroid Abnormalities
What is the best initial test for Secondary Amenorrhea?
B-HCG to R/o pregnancy
What is the order or Tests used to workup secondary amenorrhea?
B-HCG
TSH
Prolactin
FSH
Estradiol
Testosterone or Clinical Hyperandrogenism
Progesterone withdraw test
Estrogen-progesterone challenge test
